DAPT Non-inferior to Alteplase for Minor AIS

Clinical question: Is dual antiplatelet therapy (DAPT) non-inferior to intravenous (IV) thrombolysis in patients with minor non-disabling acute ischemic strokes (AIS)? Dr. Subramany Background: Minor strokes comprise about half of all AIS but the evidence for IV thrombolytics in this cohort has been inconclusive. While prior studies have confirmed the superiority and safety of short-term DAPT in acute minor strokes compared to aspirin alone; no studies have previously compared DAPT versus IV thrombolytics. Study design: Multi-center, randomized, open-label, blinded endpoint assessment, non-inferiority trial Setting: 38 hospitals in China Synopsis: 760 adult patients with AIS (National Institutes of Health Stroke Scale Score [NIHSS] <=5) presenting within 4.5 hours of symptom onset; participants were randomly assigned to DAPT (clopidogrel and aspirin for approximately 12 days) or IV alteplase. Both groups then received guideline-based antiplatelet therapy. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale score of 0 or 1, at 90 days. The median NIHSS was 2, and approximately 70% of the patients were men. At 90 days, 93.8% in the DAPT group and 91.4% in the alteplase group achieved an excellent functional outcome. The risk difference met the non-inferiority criteria (P <0.001). The alteplase group (6.5%) had more spontaneous intracranial hemorrhages and other bleeding events compared to the DAPT group (1.9%). The DAPT group had ...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: In the Literature Neurology Source Type: research